Abstract
BackgroundPreserving the hip joint to delay arthroplasty for patients with acetabular dysplasia-associated early-stage osteoarthritis has become more common, and several surgical procedures have demonstrated pain relief and improved hip joint function. Periacetabular osteotomy, one of the joint-preserving surgical procedures of the hip, provides favorable outcomes, although there are no reports of total hip arthroplasty being used to treat pseudoarthrosis of the periacetabular osteotomy segment. Therefore, we report a case of pseudoarthrosis in the osteotomy segment after periacetabular osteotomy. The patient was treated using modified total hip arthroplasty and achieved a favorable short-term outcome.Case presentationA 62-year-old Japanese woman was diagnosed with bilateral acetabular dysplasia at the age of 50 years, and underwent right and left periacetabular osteotomy at the ages of 52 and 55 years, respectively. When she was 61-years old, she experienced repeated episodes of left coxalgia during walking, with increasing pain at rest, and subsequently visited our department. Plain radiography and computed tomography of her left hip joint confirmed pseudoarthrosis of the periacetabular osteotomy segment. In addition, narrowing of her left hip joint space was observed, which indicated advanced osteoarthritis of the hip. Therefore, she underwent left total hip arthroplasty when she was 62-years old. During the surgery, fibrous fusion of the periacetabular osteotomy segment was confirmed via fluoroscopy, although no abnormal mobility was observed. Thus, the osteotomy segment was fixed with one absorbable screw and two bone pegs (which were prepared using allogeneic bone), and the acetabular cup was fixed using cement. Her postoperative course was generally favorable and bone fusion of the periacetabular osteotomy segment was confirmed at 3 years and 6 months after surgery. Her modified Harris hip score was 43 before the surgery and had improved to 90 at the final follow-up.ConclusionsModified total hip arthroplasty was successfully used to treat osteoarthritis of the hip and pseudoarthrosis of the periacetabular osteotomy segment. This procedure achieved pseudoarthrosis region bone fusion and a favorable postoperative outcome.
Highlights
Preserving the hip joint to delay arthroplasty for patients with acetabular dysplasia-associated early-stage osteoarthritis has become more common, and several surgical procedures have demonstrated pain relief and improved hip joint function
Acetabular dysplasia can cause the acetabulum to provide poor coverage of the anterior to the upper regions of the femoral head, which allows osteoarthritis of the hip to progress for an extended period
We encountered a patient who had developed pseudoarthrosis in her osteotomy segment after periacetabular osteotomy (PAO), and we successfully treated her via modified total hip arthroplasty (THA)
Summary
During developmental dysplasia of the hip (DDH), the acetabular side exhibits a sharp and shallow articular surface, while the femoral side exhibits bone morphological abnormalities, such as coxa valga and excessive femoral neck anteversion. Of her left hip joint was 90° flexion, 0° extension, 10° abduction, 10° adduction, 20° external rotation, and 10° internal rotation Radiography of her bilateral hip joints revealed no narrowing in her right hip joint, joint space narrowing and pseudoarthrosis of the PAO segment were observed in her left hip joint (Fig. 1a). Pseudoarthrosis of her left PAO segment was diagnosed at 1 year after surgery, only observation of her clinical course was performed because she did not experience any pain When she was 61-years old, left coxalgia during walking reappeared, as well as increasing pain at rest, and she visited our department. The patient’s modified Harris hip score was 43 before the surgery, and had improved to 90 at the final follow-up
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